1. Field of the Invention
The present invention relates to an endo-therapy accessory which is used through an endoscope, an endoscopic device where an endoscope and an endo-therapy accessory are combined to be used, endo-therapy accessory fixing method, and catheter exchange method.
2. Description of the Related Art
A disease in a patient's pancreatic/bile duct system or the like is generally treated by an endoscopic treatment which uses an endoscope. For the treatment of the pancreatic/bile duct system which uses the endoscope, in addition to a diagnostic treatment for imaging a bile duct or a pancreatic duct endoscopically, for example, there is a curative treatment for collecting calculus present in a choledoch duct by using a balloon or forceps, etc.
To carry out such a treatment, a guide wire is used as an endo-therapy accessory to approach the pancreatic/bile duct from a duodenal papilla. The guide wire which is generally used is formed such that a tip side part is processed to be tapered or thin in diameter, and flexibility of the tip side part is increased.
The guide wire is used when the endo-therapy accessory is guided (passed) into a portion of a narrow duct mainly such as a papilla or a stricture, or when the endo-therapy accessory is changed. In the case of carrying out an endoscopic treatment for the pancreatic duct, the bile duct or the like by using the guide wire, specifically the following work must be carried out.
This treatment necessitates at least two operators, i.e., a main operator 201 and an assistant operator 202 as shown in FIG. 20A and FIG. 20B. The main operator 201 operates the endo-therapy accessory out of a biopsy valve 219 of an endoscope 210 by a right hand while gripping an operation section 212 of the endoscope 210. The assistant operator 202 has a role to assist the main operator 201.
As shown in FIGS. 20A and 20B, the main operator 201 inserts a tip 214 of an insertion portion 213 of the endoscope 210 near a duodenal papilla beforehand. After checking of insertion of a tip 214 near a papilla of a duodenum, the main operator 201 inserts a catheter 216 through an endo-therapy accessory channel disposed in the insertion portion 213 of the endoscope 210 from the biopsy valve 219 of the endoscope 210 to project a tip part 216b of the catheter 216 from a tip 214 of the insertion portion 213 of the endoscope 210, and passes the tip part 216b of the catheter 216 from the papilla through a stricture or a stone in a pancreatic duct or a bile duct to a desired position. The main operator 201 or the assistant operator 202 inserts a guide wire 218 from a valve 216a of a rear side of the catheter 216 inserted through the endoscope into a pancreatic duct or a bile duct through an inner hole of the catheter 216 toward a tip of the catheter 216.
After a tip of the guide wire 218 is projected from a tip 216b of the catheter 216, the tip of the guide wire 218 is inserted through the papilla into the pancreatic duct or the bile duct. Then main operator 201 checks the sufficient insertion of the tip of the guide wire 218 to the desired position in the pancreatic duct or the bile duct under X-rays. Alternatively, for example, if the catheter 216 cannot pass through a very narrow duct part such as the stricture or the stone in the pancreatic duct or the bile duct because the tip of the guide wire 218 is small in diameter or flexible, the guide wire 218 is preferentially inserted into a desired position, and then the catheter 216 is guided by using the guide wire as a guiding tool.
When another treatment is carried out after the end of the treatment which uses the catheter 216, the endo-therapy accessory is changed. The main operator 201 pulls the catheter 216 from the endo-therapy accessory channel of the endoscope 210 in a state where the guide wire is detained from the papilla into the pancreatic duct or the bile duct. When the main operator 201 pulls out the catheter 216 from the endo-therapy accessory channel of the insertion portion 213 of the endoscope 210, a friction force is generated between the catheter 216 and the guide wire 218 to pull the guide wire 218 integrally to the hand side. At this time, delicate collaborative work is carried out: the main operator 201 pulls the catheter 216 to the hand side by 20 mm while the assistant operator 202 inserts the guide wire 218 into the catheter 216 relatively by 20 mm (actually not moved). To carry out this work, the main operator 201 and the assistant operator 202 must carefully work in close cooperation.
During this work, as shown in FIG. 20B, when the tip 216b of the catheter 216 comes out of the biopsy valve 219 of the operation section 212 side of the endoscope 210, the main operator 201 grips the rear end side of a guide wire 218 near the biopsy valve 219 of the endoscope 210 so as to prevent falling-off of the tip of the guide wire 218 from the inserted position. The assistant operator 202 pulls out the catheter 216 from the rear end of the guide wire 218. By such work, the catheter 216 is pulled out from the endo-therapy accessory channel while the guide wire 218 is left in the desired position.
Then, the rear end side of the guide wire 218 is inserted into an insertion hole of another endo-therapy accessory in place of the catheter 216 and, by using the guide wire 218 as a guiding tool, this endo-therapy accessory is inserted into the endo-therapy accessory channel of the insertion portion 213 of the endoscope 210. The endo-therapy accessory is guided into the pancreatic duct or the bile duct by the guide wire 218. Thereafter, work of inserting/pulling-out the endo-therapy accessory in a state where the guide wire 218 is left in a desired position is repeated by the number of times of exchanging the endo-therapy accessory.
Incidentally, for example, U.S. Pat. No. 5,084,022, U.S. Pat. No. 5,379,779, and Jpn. Pat. Appln. KOKAI Publication No. 2003-93516, there is disclosed a technology which has markings (indexes) formed on a guide wire to measure an insertion length disposed in an insertion portion of an endoscope, a lead-out length from a tip of the endo-therapy accessory channel etc.
The specification of U.S. Pat. No. 5,084,022 discloses a technology which has markings formed at equal intervals along a longitudinal direction of a guide wire. Each marking is disposed in a streaky shape in a circumferential direction of the guide wire. For the markings, the number of streaks is gradually increased toward a hand side of the guide wire. As a distance from a tip of the guide wire to a position of the marking is known beforehand, the number of marking streaks observed from a distal end of the endoscopic insertion portion is checked by an observation monitor to measure a distance from the tip of the guide wire. That is, when such a guide wire is used, a marking projected from a papilla to a proximate side is checked by a monitor of the endoscope in a state where the tip of the guide wire is arranged in a treatment/diagnosis position of the pancreatic/bile duct. By using this monitor to check on the number of marking streaks, a distance from the treatment/diagnosis position to the papilla is measured.
The specification of U.S. Pat. No. 5,379,779 discloses a technology of a guide wire which has radiopaque markings. This guide wire is used to measure a length of the inside of the papilla which cannot be checked by the endoscopic monitor. By checking on the tip of the guide wire, the papilla and radiopaque markings on the guide wire of the papilla portion, a projected length of the guide wire from the tip of the endo-therapy accessory or the like is measured.
In Jpn. Pat. Appln. KOKAI Publication No. 2003-93516, markings are disposed in positions where structural characteristics of the guide wire are changed. Thus, when the guide wire is observed through the endoscope, the positions of structural characteristic changes of the guide wire are easily recognized visually.
Additionally, Jpn. Pat. Appln. KOKAI Publication No. 2002-34905 discloses an endoscope which can lock a guide wire having flexibility. An endo-therapy accessory elevator is disposed in a distal end of an insertion portion of the endoscope of this technology. A V-shaped wire-locking groove is disposed in the endo-therapy accessory elevator. If the forceps elevator is lifted while the guide wire is arranged in the wire-locking groove, the guide wire is bent, and locked by a reactive force generated when the bent guide wire returns to its original state. Accordingly, certain hardness is necessary to lock the guide wire. When work is carried out by using this endoscope to pull out the catheter from the endo-therapy accessory channel, in a state where a tip of the catheter is pulled into a distal end of the endoscope, the forceps elevator is lifted to lock only the guide wire thereon. Since the guide wire is locked on the forceps elevator not to be moved, in work thereafter, the main operator can leave the guide wire in a desired position by pulling out the catheter. That is, it is not necessary for the assistant operator to carry out work of relatively inserting the guide wire into the guide catheter.